Constipation

Constipation is a symptom rather than a disease, generally defined as when bowel movements occur three or fewer times a week and are difficult to pass. It is a common cause for referral to gastroenterologists and colorectal surgeons. Despite its frequency, it often remains unrecognized until the patient develops sequelae, such as anorectal disorders.

Signs and symptoms:

According to the Rome IV criteria for constipation, a patient must have experienced at least two of the following symptoms over the preceding 6 months:

  • Fewer than three spontaneous bowel movements per week
  • Straining for more than 25% of defecation attempts
  • Lumpy or hard stools for at least 25% of defecation attempts
  • Sensation of anorectal obstruction or blockage for at least 25% of defecation attempts
  • Sensation of incomplete defecation for at least 25% of defecation attempts
  • Manual manoeuvring required to defecate for at least 25% of defecation attempts

 

In addition, the patient must rarely have loose stools present without use of a laxative and must not meet Rome IV criteria for irritable bowel syndrome (IBS).

A constipated patient may be otherwise totally asymptomatic or may complain of one or more of the following:

  • Abdominal bloating
  • Pain on defecation
  • Rectal bleeding
  • Spurious diarrhoea
  • Low back pain

 

The following also suggest that the patient may have difficult rectal evacuation:

  • Feeling of incomplete evacuation
  • Digital extraction
  • Tenesmus
  • Enema retention

 

The following signs and symptoms, if present, are grounds for particular concern:

  • Rectal bleeding
  • Abdominal pain [suggestive of possible IBS with constipation (IBS-C)]
  • Inability to pass flatus
  • Vomiting

Causes of Constipation:

  • Diet: Not eating enough fiber or drinking enough fluids can lead to constipation.
  • Lifestyle: Lack of exercise, ignoring the urge to have a bowel movement, and stress can all contribute to constipation.
  • Medications: Certain medications, such as iron supplements and pain medications, can cause constipation as a side effect.
  • Medical conditions: Some medical conditions, such as irritable bowel syndrome (IBS), hypothyroidism, and diabetes, can cause constipation.

 

If you are experiencing constipation, it is important to see your doctor to rule out any underlying medical conditions. Your doctor can also help you determine the cause of your constipation and recommend treatment options.

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